GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC. (NPI# 1649510744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649510744 |
| Entity Type | Organization |
| Organization Name | GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC. |
| Practice Address |
106 Westside Dr Dothan AL 36303-1908 |
| Mailing Address |
2505 Harrison Ave Panama City FL 32405-4423 |
| Practice Telephone | 8502333376 |
| Practice Fax Number | 8505228354 |
| Mailing Telephone | 8502333376 |
| Mailing Fax Number | 8505228354 |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2013-03-20 |
| Authorized Official Name | JON R WARD (PRESIDENT) |
| Authorized Official Telephone | 8502333376 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | APPLYING FOR | 05 | |
| FL | APPLYING FOR | 05 |
| Street Address |
106 WESTSIDE DR |
| City | DOTHAN |
| State | AL |
| Zip Code | 36303-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891206439 | Allie Sarah Alford | Physician Assistant | 106 Westside Dr, Dothan, AL 36303 | 2017-10-23 |
| 1992236889 | Sydney K Givens | Physician Assistant | 106 Westside Dr, Dothan, AL 36303-1908 | 2017-03-23 |
| 1255798047 | Rachel Brooks | Physician Assistant | 106 Westside Dr, Dothan, AL 36303-1908 | 2016-01-25 |
| 1730432311 | Amanda Lynn Day | Physician Assistant | 106 Westside Dr, Dothan, AL 36303-1908 | 2012-10-19 |
| 1134498132 | Kelli Nicole Heer | Physician Assistant | 106 Westside Dr, Dothan, AL 36303-1908 | 2011-12-20 |
| 1013973692 | Jeffrey B Stricker | Dermatology | 106 Westside Dr, Dothan, AL 36303-1908 | 2006-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194205740 | Emblom & Vaughn, D.m.d., PC | Dentist | 318 Healthwest Dr., Dothan, AL 36303 | 2018-08-14 |
| 1164887907 | Bio-medical Applications of Alabama, Inc. | Clinic/Center | 118 Obrannan Park Drive, Dothan, AL 36303 | 2015-12-21 |
| 1245634245 | Api Counseling, LLC | Community/Behavioral Health | 1583 Montgomery Highway, Dothan, AL 36303 | 2014-10-20 |
| 1467792382 | Bolanle Boladale Akinduro | Home Health | 107 Hidden Glen Way, Dothan, AL 36303 | 2013-03-01 |
| 1104162114 | Al Dental PC | Dentist | 3400 Montgomery Highway, Dothan, AL 36303 | 2012-12-19 |
| 1659661874 | Juanita Titrud Heersink | Internal Medicine | 210 Westside Drive, Dothan, AL 36303 | 2011-04-08 |
| 1790918548 | Brandi Bradshaw Reeves | Counselor | 100 Westside Dr., Dothan, AK 36303 | 2009-08-27 |
| 1396917589 | Brian Davis | Physical Therapist | 3763 Ross Clark Circle, Dothan, AL 36303 | 2008-03-27 |
| 1558544544 | Healthwest Dental Associates PC | Dentist | 502 Healthwest Drive, Dothan, AL 36303 | 2007-12-12 |
| 1770644775 | Christine Carroll Fain | Occupational Therapist | 3763 Ross Clark Cir Ste 1, Alacare Home Health, Dothan, AL 36303 | 2006-12-13 |
| Find all providers in zip 36303 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366629917 | Jeffery L Walding | Surgery | 2800 Ross Clark Cir Ste 2, Dothan, AL 36301-9917 | 2008-01-25 |
| 1639372725 | Justin Parish Martin | Surgery | 2431 W Main St Ste 302, Dothan, AL 36301-1251 | 2007-06-07 |
| 1114062106 | Luther Dwight Baker | Surgery | 105 Professional Ln, Dothan, AL 36303-3875 | 2007-02-20 |
| 1811285968 | L. Dwight Baker, M.d., P.C. | Surgery | 105 Professional Ln, Dothan, AL 36303-3875 | 2011-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780056945 | Melanie Petro Md LLC | Surgery | 905 Moontgomery Highway, Birmingham, AL 35216 | 2015-10-28 |
| 1316100670 | Patrick C Wilson | Surgery | 805 Madison St., Suite 1d, Huntsville, AL 35801 | 2008-07-08 |
| 1245456805 | Michael D. Yates, Md, PC | Surgery | 303 Williams Av Sw, Suite 1421, Huntsville, AL 35801-6008 | 2007-04-18 |
| 1932267218 | Gordon Michael Telepun | Surgery | 1206 Somerville Rd Se, Decatur, AL 35601 | 2006-12-05 |
| 1316014681 | Plastic Surgery Inc | Surgery | 701 University Blvd Medical Tower, Suite 902, Tuscaloosa, AL 35401 | 2006-11-29 |
| 1326066010 | Randy D. Proffitt, M.d., LLC | Surgery | 6317 Piccadilly Square Dr, Mobile, AL 36609-5103 | 2006-07-18 |
| 1528085347 | Randy Douglas Proffitt | Surgery | 740 Hillcrest Rd, Suite C, Mobile, AL 36695-3924 | 2006-07-16 |
| 1871531681 | Curtis N Harris | Surgery | 1601, Ste 2n, Mobile, AL 36604-1512 | 2006-06-03 |
| 1538122080 | David L. Durst | Surgery | 4011 Balmoral Dr Sw, Huntsville, AL 35801-6403 | 2006-04-07 |
| 1346808508 | Usa Health Physician Billing Services LLC | Surgery | 1601 Center St, Mobile, AL 36604-1541 | 2019-06-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.